Anatomic Pathology

Anatomic pathology refers to the study of body tissue and cells. Cytology and Histology sections comprise the Department of Anatomic Pathology. The cytology department processes pap smears, fine needle aspirations and a variety of body fluid specimens. The histology department processes biopsies and other surgical specimens.

Anatomic Pathology Services - Histology

The histology section receives biopsies and resected body organs. The pathologist determines if disease is present by evaluating these tissues under the microscope. The tissues are placed in small plastic boxes, called cassettes, which are then processed through a variety of chemicals. The final step coats the tissue with paraffin so it can be placed on a microtome, a specialized knife, and sectioned. The thin, tissue paper-like specimen is then gently laid on a glass slide which is then processed through a variety of stains. The processing, sectioning and staining of the tissue is performed by a certified histotechnologist. The pathologist then views the final product under the microscope.For further information call: 217-464-2074

Anatomic Pathology Services - Cytology

Experienced, qualified, licensed cytotechnologists and cytopathologist staff the Cytology Department. Specimens are obtained and placed in a special fluid for processing. A single layer of cells is transferred to a glass slide then stained so the cells are visible. These slides are then examined in detail under the microscope. The most common specimens examined are Pap Tests. The emphasis is the detection of malignant or pre-malignant cells. The examination can also detect inflammation and the presence of certain microorganisms. The Cytology department also examines samples from other various body sites including urine, sputum and other body fluid specimens. The primary goal is to determine if malignant cells are present.

For further information call: 217-464-2060

Anatomic Pathology Services - Pap Test

The Pap Test (Smear) has been the recipient of much criticism over the past few years. Isolated negative experiences have been generalized. However, the fact remains that in the highly screened population (many women getting Pap Tests), the cervical cancer rate is approximately 80% lower than in the unscreened population (few women getting Pap Tests).

Misconceptions arise from the fact that women believe that Pap Tests are highly accurate. In fact, the Pap Test is a "screening" test rather than a "diagnostic" test. This means that the results of the test should only assign a probability that the disease exists in an individual. There are chances for error in both the collection of the specimen by the clinician and interpretation of the smear by the cytotechnologist or pathologist. It is estimated that there is an unavoidable false negative rate (meaning that abnormal cells are present when a diagnosis of "normal" is received) of about 5%. The unavoidable false negative samples result from inadequate specimen collection (the abnormal cells were not picked up by the brush or spatula used to obtain the sample from the cervix) or by errors in screening. The latter can result from the presence of only a few abnormal cells hiding among millions of normal cells.

Alternatively, abnormal cells may be present but misidentified as cells that are not concerning (for example, a fungus infection or trauma can illicit an abnormal cellular response, but this does not indicate that a pre-malignant condition exists).

The most important thing to note is that the Pap test is a great test, but not a perfect test. There are certain things that a woman can do to assure that the most optimal testing is being provided:

Make sure you have a Pap Test every 1-3 years, as directed by your physician.

Do not have a Pap Test taken during your menstrual period. The optimal time for having a Pap Test is mid-way during the menstrual cycle.

Do not use a douche preparation before the Pap Test is to be taken.

Ask your physician about the laboratory that will be examining your test. Make sure that laboratory is following the appropriate procedures:

Your specimen is submitted in a liquid-based media. The old smear technique is less likely to find abnormal cells as compared to ThinPrep (a brand-name liquid cytology system used at St. Mary’s laboratory).

The laboratory reports whether or not the specimen is satisfactory for interpretation. At times, there is obscuring inflammation or blood that can make interpretation of the test difficult. Your physician should be notified of this fact.

Make sure the laboratory reports in a "Bethesda-type format". This means that the "Class system" is not used. In the past, a Pap Test would be diagnosed as Class I-V. It is now appropriate to issue a descriptive diagnosis (i.e. moderate dysplasia, rather than Class IV).

Determine that at least 10% of all Pap Tests that are interpreted by the cytotechnologist (the individual who first screens all smears) as "normal,” are reviewed by a pathologist or senior cytotechnologist.

Determine that the cytotechnologists are not required to screen a certain number of slides per day. The cytotechnologist should screen at a rate at which they feel comfortable, and the laboratory should monitor the number of abnormal cases diagnosed by that cytotechnologist in comparison to the rest of the staff.

Determine that the laboratory issues an annual report documenting certain data including false negative and false positive rates, as well as the number of cases diagnosed as abnormal.The Pap Test exam has been very effective in reducing the incidence and mortality of cervical cancer. However, women should not think of a single Pap Test as being the perfect test. By undergoing multiple Pap Test examinations, and determining that a quality laboratory is screening the slides, women can be assured that the outcome will be worth the time and effort put into obtaining the test.

Fine needle aspiration is performed in the Department of Cytology. Most patients are undergoing an examination of a lump or mass identified in the breast, thyroid, lymph nodes (lymph glands) or other areas where the mass is easily identified beneath the skin. Masses that are identified in the lung, liver, kidney or other internal organs are also able to be biopsied in this fashion, by a radiologist. These aspirations are performed in the Department of Radiology and examined by a pathologist.

Indications for Fine Needle Aspiration

A lump may result from many different causes including infection, a benign growth or malignant growth. The majority of lumps are not malignant but determining the nature of the lump is important to your doctor's decision on how to treat. Fine needle aspiration is a reliable, fast and safe method to obtain this information so correct treatment can be recommended to you.

What You Can Expect at Your Appointment

When you arrive for your appointment our staff will obtain some preliminary historical information from you. You will then discuss your medical problem with a laboratory physician, the pathologist. The details of the procedure will be discussed with you and the area to be biopsied will be examined and evaluated. If the lump is determined by the pathologist to be appropriate for fine needle aspiration, the procedure will then be performed. Approximately 5% of lumps are found to be inappropriate for this technique and are not biopsied.

How the Biopsy Is Performed

The fine needle aspiration is a safe and simple procedure designed to biopsy a lump without making an incision. After the lump has been identified, the skin overlying the lump is thoroughly cleansed with alcohol. A very small needle, attached to a syringe is passed through the skin into the lump. The needle is smaller than that commonly used by most laboratories to draw blood from your arm. For this reason, it is not necessary to numb the skin. With the needle in place, the plunger on the syringe is drawn back and the needle moved to collect the material. During the procedure you will probably experience a brief discomfort similar to that encountered when blood is drawn from your arm. The aspiration takes only a few seconds to perform. To assure that the lump is adequately sampled, 2 or 3 biopsies are usually performed.

Limitations on Activity After the Biopsy

The biopsy procedure will not limit your routine daily activities. You should continue to take any medications that have been prescribed for you by your physician, as the biopsy does not affect these medicines.

Length of Procedure

You should anticipate approximately 30 minutes at the Cytology Department. The actual procedure takes approximately 10 minutes once it has started.

Results

A written report of the results will be sent to your physician's office within 24 hours of the procedure. However, you should allow time for the physician to review your test results and determine what treatment or additional treatment is necessary. You should call your doctor's office directly to obtain results to the test.

Risks

Fine needle aspiration procedure poses no significant risks. The complications are the same that might occur when having your blood drawn. A small bruise may develop at the site of the biopsy. A transient throbbing discomfort may be experienced. Over the counter pain relievers usually control most of the discomfort encountered. Should any unusual discomfort or swelling in the area occur, you should contact your doctor. Although any device passing through the skin poses a remote possibility of infection, none have been reported at our facility. The risk of an infection occurring with your procedure would be essentially the same you might anticipate with having blood drawn from your arm.

Our experience at this hospital indicated that approximately 70% of the time we will be able to tell your physician exactly what the nature of the lump is so that a treatment may be prescribed. In some of the cases, we will not be able to specifically classify the process taking place, but will be able to provide enough information that will allow a judgment to be made about what, if any thing, further needs to be undertaken. In approximately 10% of cases, in spite of best efforts, the biopsy procedure yields too little material to make any statement regarding the nature of the lump. When this occurs, your physician may decide to have a fine needle aspiration biopsy repeated, have the lump surgically removed or perform other tests.

Accuracy

It is important to remember that fine needle aspiration procedure, like any other laboratory test, can occasionally be inaccurate. The rate at which this procedure does not find disease, if present, is very low, approximately 2-4%.